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Pediatric Population Health Outcomes
Using Condition-Specific Registries
Session 73, February 12, 2019
Brian Jacobs MD
VP, CMIO & CIO
Children’s National Medical Center
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Brian Jacobs, MD
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Pediatric Demographics in the Washington DC
Metropolitan Region
• Principles of Health Registry Development
• Data Quality Challenges
• Delivering on a Population Health Corporate Goal
• Lessons Learned for the Future
Agenda
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• Recognize what is required to construct and implement a
condition-specific pediatric registry that conforms to accepted,
evidence based guidelines of care
• Evaluate the value achieved and challenges encountered through
implementing these population health technologies
• Identify possible data integrity challenges and best practices to
overcome these challenges with successful outcomes
Learning Objectives
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Children’s National Medical Center
• 313-bed acute care hospital
• 2 pediatric emergency departments
• Level I trauma center
• Critical care transport program
• Community-based primary care
network
• Primary care offices in DC and MD
• 7 regional outpatient centers
• Ambulatory surgery center
• School nurse program
• Medical collaborations across the
region
• Mobile health services
Serving over 219,000 patients annually
• $ 1.3 B Budget Health System
In FY 17:
• Discharges – 15,554
• Emergency Room Visits – 120,648
• Outpatient Visits – 560,810
• Surgery Cases – 17,535
1870
Today
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Population Health Efforts
at Children’s National
Regional Pediatric Population:
• 125 K Children in DC
• 1.9 M Children in VA
• 1.4 M Children in MD
Children’s IQ Network:
• 65 Practices
• 340 Independent Providers
• ~450K unique children
Children’s National:
• ~220K unique children
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Enterprise Data
Warehouse
> 3M Encounters
> 660,000 Unique Children
Schools
Greenway
Primary
Care
Payer
Claims
Epic
PSV
CNMC
Billing
Cerner
IP, ED, OR
Specialty
Clinics
eCW
Primary
Care
Population Health
Registries
Data Sources to Enterprise Data Warehouse
Immunization
Registries
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Core Principles in Registry Development
• Executive Leadership
• Published Peer-Reviewed Evidence
• Consensus
• Measure Selection
– Objective
– Structured
– Available
• EHR Workflow Integration
(Cerner, eClinical Works, Greenway)
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Population Health Registries
Asthma Cardiomyopathy Diabetes
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Action Plan Complete
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Medication Management
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Lung Function Testing
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Asthma Control Test
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Influenza Vaccination
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Tobacco Screening &
Cessation
•
Tobacco Exposure
Screening
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Outpatient Visit
•
ED Visit
•
Hospital Visit
•
Echocardiogram
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Outpatient Vital Signs
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Outpatient EKG
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Routine Holter Monitor
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Routine Labs
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Blood Pressure Control
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Blood Pressure > 130/90
mm Hg
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Body Mass Index
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Outpatient Visit
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ED Visit
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Hospital Visit
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HbA1C Screening
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HbA1C < 7.5%
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HbA1C < 9.0%
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HbA1C > 10.0%
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Lipid Panel
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LDL < 100 mg/dL
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LDL > 130 mg/dL
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Microalbumin Screening
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Thyroid Function Screening
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Celiac Screening
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Blood Pressure Measurement
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Blood Pressure >
130/90 mm Hg
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Body Mass Index
•
Pneumonia Vaccination
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Population Health Registries
IBD Epilepsy Sickle Cell
• Nutrition Assessment/Counseling
• Tuberculosis (TB) Testing
• Hepatitis B Vaccination
• Varicella Vaccination
• Eye Exam
• Adolescent Depression
Screening
• Blood Pressure Measurement
• Routine Labs
• Body Mass Index
• Routine Urinalysis
• 6 MP and Imuran Labs
• Methotrexate Labs
• Contraceptive Education
• Outpatient Visit High Risk
• Outpatient Visit Low Risk
• ED Visit
• Hospital Visit
• Bone Mineral Testing
• Brain MRI
• DMV Notification
• Diastat Prescription
• Electroencephalogram
• ED Visit
• Emergency Seizure
Action Plan
• Felbamate Labs
• Hospital Visit
• Motor Vehicle
Education
• Outpatient Visit
• Reproductive Education
• Routine Labs
• Surgical Referral
• Antibiotic Prophylaxis
• Blood Pressure < 140/90 mm Hg
• Chronic Transfusions – Labs
• Chronic Transf – Audiology Exam
• Chronic Transf – Ferritin
• Chronic Transf – Neuro Testing
• Chronic Transf – T2 Level
• Chronic Transf – Viral Testing
• Eye Exam
• Genetic Counseling: 12 Years
• Genetic Counseling: New Condition
• Hydroxyurea Treatment
• Hydroxyurea Treatment Education
• Meningococcal Vaccination
• Pain Assessment
• Pain Assessment Follow Up
• Pneumococcal Vaccination
• Proteinuria Screening
• RBC Phenotyping
• Spirometry Evaluation
• Stroke Prevention
• Well Visit
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Question 1
Which of the following factors contribute to data
quality challenges in population health:
1. Inconsistent structured documentation during a clinic
encounter
2. Narrative documentation
3. Mapping errors from the EHR to the data warehouse
4. All of the above
https://live.eventbase.com/polls?event=himss19&polls=5128
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Data Quality is Challenging!
• Health quality measure performed, but not in
accessible system (e.g. retail pharmacy
immunization at CVS)
• Measure performed but not documented
(e.g. discussion on seizure action plan)
• Care ordered but not carried out
(e.g. ordered Valproate, no show in lab)
• Measure documented in an unstructured
(narrative) manner
• Mapping from EHR to EDW is inaccurate &
requires correction
• Mapping from EDW to Registry is inaccurate
& requires correction
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Perceived vs. Reported Value
Reported
Perceived
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2018 Corporate Goal
Definition: Advance quality outcomes in selected population health
diagnoses across the continuum of care through electronic health registry
data.
Rationale: Through 6 population health registries: asthma,
cardiomyopathy, diabetes, inflammatory bowel disease, epilepsy, and
sickle cell, improve the outcome in each registry by 10% from baseline for
each health condition.
FY18 Incentive Goal Metrics
Threshold
Improve outcomes of care using 3 registries.
Target
Improve outcomes of care using 4
registries.
Maximum
Improve outcomes of care using 5 registries.
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Question 2
Which factor(s) below are most predictive of
clinician participation in population health?
1. Integration of Registry Measures Into Clinician
Workflow
2. Distribution of Starbucks Gift Cards
3. Importance of Displayed Health Measures
4. Answers 1 & 3
https://live.eventbase.com/polls?event=himss19&polls=5129
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Registries
integrated into
EHR daily work
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Ambulatory Summary View
(Sickle Cell Disease)
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Ambulatory Workflow View
Sickle Cell Disease
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Registry Measure View
Cardiomyopathy
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Corporate Goal Performance
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Lessons Learned
Data
Integrity
Patient
Engagement
Clinician
Adoption
• Onboarding Data
• Data Validation &
Quality
• External Scanned Data
• Data Steward
Resources
• Clinician Workflow
Adoption
• Structured Clinician
Documentation
• Community Physician
Engagement
• Care Coordination
• Care Coaching
• Patient Outreach
Resources
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Question 3
According to a 2016 survey, which of the following is a
true statement?
1. <20% of healthcare organization revenue is now
associated with risk-based contracting
2. 45% of healthcare executives rank population health as
moderately to critically important
3. 30% of health care organizations have at least one risk
based contract
4. None of the above
https://live.eventbase.com/polls?event=himss19&polls=5130
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Conclusions
• Essential health data from information systems can be
aggregated to power robust population health analytics.
• Data quality is challenging and should be appropriately
resourced
• Condition-specific pediatric health registries can be
utilized to identify opportunities to improve care.
• Integrating these opportunities into clinicians workflows
results in improved health measure compliance
• Further improvements will likely require:
– Empowering patients with this information through
enhanced communication tools
– Health coaching and care coordination
